Dr. Bobby Milstein | Beyond Reform and Rebound

Bobby Milstein, PhD, MPH, director of the ReThink Health and visiting scientist at MIT Sloan School of Management, gave the October 9 Grand Rounds on the Future of Public Health at Columbia's Mailman School of Public Health. Dr. Milstein's talk, "Beyond Reform and Rebound: Frontiers for Rethinking and Redirecting Health System Performance," was part of this year's Grand Rounds series focusing on the decline in the health status of the U.S. population compared to peer nations, as well as the opportunities for public health leadership that are needed to close this gap. While at the Mailman School, Dr. Milstein also met with a group of doctoral students and Prof. Ronald Bayer to discuss approaches to effectively improve health systems in the United States.

Visit the events page to find out more, http://www.mailman.columbia.edu/events/grand-rounds.

2.
More Money for Shorter Lives
Commission to Build a Healthier America. America is not getting good value for its health dollar.
Robert Wood Johnson Foundation 2008.
Institute of Medicine. U.S. Health in International Perspective: Shorter Lives, Poorer Health.
Washington, DC: National Academies Press; 2013.
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7.
September 26, 2013
September 27, 2013
Seigal Bernard T. A Guide to the New Exchanges for Health Insurance. New York Times 2014 September 27.
Abelson R. As Some Companies Turn to Health Exchanges, G.E. Seeks a New Path. New York Times 2013 September 26.
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8.
General Electric. Building Better Healthcare Value in Cincinnati: How Employers are Collaborating with Other Healthcare
Stakeholders to Improve Health and Reduce Costs in the Queen City. Fairfield, CT: Healthymagination; 2013.
Available at http://www.ge.com/globalimpact/pdf/Building_Better_Healthcare_Value_in_Cincinnati.pdf
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14.
“Most Triple Aim projects start with a
project and build up from there.”
“We have been thinking big picture and
ReThink Healthspecific projects yet.”
haven't selected Dynamics
Triple Aim
Collective
Impact
Pueblo’s
Health
System
• How is the health system
structured?
“We are building governance, structure,
andHow and first becauseit change our
• strategy when does we believe
work will change)?
(or resist be more successful and
sustainable with this approach.”
• Where is the greatest leverage?
-- Donald Moore,
• What trade-offs are involved?
CEO Pueblo Community Health Center
Milstein B, Hirsch G, Minyard K. County Officials Embark on New, Collective Endeavors to ReThink Their Local
Health Systems. Journal of County Administration, March – April 2013.
Available at http://tinyurl.com/RTH-County-Officials
Milstein B. ReThinking Health in Pueblo, Colorado: A Stewardship Strategy to Advance the Triple Aim. Improving
Population Health. August 21, 2012. Available at http://tinyurl.com/RTH-Pueblo-Story
Kindig D, Milstein B. From ACOs to Accountable Health Communities: Delivering on Population Health in the
Triple Aim. Institute for Clinical Systems Improvement Reinertsen Lecture. October 25, 2012; Minneapolis, MN.
Available at https://www.icsi.org/education__services/reinertsen_lecture/
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25.
In 2010, about how much
did Atlanta spend on
personal health care services?
1. $700 million
2. $3 billion
What could we accomplish
by devoting just 1% to
system change initiatives?
3. $11 billion
4. $6 billion
* Atlanta = Fulton + Dekalb county
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39.
Challenge: Craft a scenario that ought to
work well: a vision for Atlanta you might
be proud to enact
Some Tips
Discuss what you value and how to achieve it
Consider both actions and funding
Limit = 5 initiatives + any financing options
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50.
Challenge: Few regions have sturdy multi-stakeholder teams to negotiate
agreements and serve as stewards of their common health system
Ostrom E. Beyond Markets and States: Polycentric Governance of Complex Economic Systems.
The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel; Stockholm; 2009 December 8.
Available at http://www.nobelprize.org/nobel_prizes/economic-sciences/laureates/2009/ostrom-lecture.html
McGinnis MD. Caring for the Health Commons: What it is and Who's Responsible for it: Social Science Research
Network; 2013 February 20. Available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2221413
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52.
Three Central Challenges
•
Fragmented, short-term investments—prone
to reform and rebound—are unable to alter
trends in health system performance
•
Few innovators appreciate the variety and
potential stakes involved when deciding
among financing options
•
Few regions have multi-stakeholder teams to
negotiate agreements and serve as stewards
of their common health system
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53.
Learn with leaders in context
• How are innovators devising new ways to
pay for and sustain necessary investments?
• Who decides?
Two-phase, exploratory project
• Refine framing and narrative
• Characterize conditions, opportunities, and
obstacles in different contexts
• Develop tools and guides for groups at different
stages of readiness, with insights from other
countries and sectors
• Craft hypotheses for directed tests
• Expand a learning network
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54.
More Money for Shorter Lives
Four Promising Shifts…
 Nation to Nested
 Sectors to System
 Goals to Pathways
 Scarcity to Abundance
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